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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 Blake Avenue
Glenwood Springs, Colorado 81601
PERMIT H S in (this does not constitute
a building or use permit)
Owner fl *vld C Nark
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System Location. Lnt 1$ nf Seetlnn 17. in Tract 37 nf Sertinn it T 7 S. R. 88 W .
Licensed Contractor 0 0 E
* Conditional Construction approval is hereby granted for a /on gallon
Septic Tank or Aerated treatment unit. f:w4u - " ,u,- (-4 "r#Lie
Absorption area (or dispersal area) computed as follows:
Pere rate / inches in /5 minutes 2 sq. ft.
absorption area per bedroom ~�
# of bedrooms x 2 °O sq. ft. minimum requirem 6l7O.f
May we suggest 2 . �
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Date 7 7`; ' Inspector �- ` E"
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system
is approved prior to covering any part.
4C Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
- Adequate absorption (or dispersal) area.
6e-- Adequate compliance with permit requirements.
4 -- Adequate compliance with County and State regulations /requirements.
4 -�7 7 � /
Date � Inspector � '
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations,
adopted pursuant to authority granted in 66.444, CRS 1968, amended 66.8.14, CRS 1963.
2. This permit is valid only for connection to structures which have fully complied with County Zoning and
building requirements. Connection to or use with any dwelling or structures not approved by the building
and Zoning office shall automatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
8. Section 1II, 8.24 requires any person who constructs, alters, or installs an individual sewage disposal
system in a manner which involves a knowing and material variation from the terms or specifications con-
tained in the application of permit commits a Class I, Petty Offense ($500.00 fine • 6 months in jail or
both. �,
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COLORADO DEPARTMENT OF HEALTH 7/7 C f
$ Water Pollution Control Division
4210 East Ilth Avenue •
Denver, Colorado 80220 •
NOTIFICATION OF PROPOSED DISCHARGE TO. WATERS OF THE STATE*
INDIVIDUAL HOME SEWAGE TREATMENT SYSTEM**
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Owner: Da.Uirl Cl. BBP.l`_K
Mail Address: 007a 13/ 12d, Cl tyakla,o»nA 4ip 316 0( Phone 946 g2021
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: •
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography or area, habitable build;ngs, location of potable water wells,
soil percolation test holes, soil profiles in test holes.
1. Location of facility: County C-inrrk i'Act .Clty or town r/Idripealr6fc_
Laud ;dua.ded rul of Lk o {section 17 — rfact 37 of sec, 17 � rcwus6;p7&„
Legal descriptionJT7S R�8W1aPrtis4t"Eat,ILot size e 5.1 - I aeres
2. No. of bedrooms 3 Septic tank capacltyAeration unit capacity
3. Source of domestic water: Public (name):
612604
Private: Well Depth Other_ X Depth to first ground water table
4. Is facility within boundaries of a city /town or sanitation district? Jp
5. Distance to nearest sewer system: /11/46
Have you attempted to arrange a connection with the system? A.10
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If rejected, what was the reason? c pts V of
6. Rate of absorption in test holes shown on the location neap, in minutes per inch
of drop in water level after holes have been soaked for 24 hours •
� ER rT ( T
7. Name, address, and telephone of person who made soil absorption tests:
p CT 1?-4k (
8. Name, address, and telephone of person responsible for design of the system:
C.: — 117
Date Si nature of Owner
*Required by Article 66- 28- 12(CRS, 1963, 1967 Perm. Sum. Supp.)
**Required in areas which have been identified as areas in which da mer of pc;lutio'
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in Ai: h the,•.:
is no local septic tank ordinance.
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B. SIGNATURES OF LOCAL OFFICIALS: The undersigned have reviewed the notification
described on the front of this sheet and recommend approval or disapproval of
the discharge as shown - below:
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Date Approval Disapproval
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Slgnature for Local Health Department
Signature for City /Town Official (Title
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Signature for County Official (Title
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Comments:
Signature and Title
Note: The Notifier (front of this sheet) must obtain comments and signature of at
least one of the above.
C. FOLLOWING FOR STATE HEALTE DEPARTMENT USE: Recommendations of the District Engineer:
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D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
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lIP- 33(10 -72 -2)